Updated 05.54 | Published 05.54
unsaveSave
expand-left
full screen Photo: Fredrik Sandberg/TT
A custom-built chatbot will make care more modern.
But the apps have also missed a heart attack and judged a hand pain as urgent.
– We who work in primary care and handle most of the cases on the floor, are completely convinced that this is a crazy product, says doctor Alexander Wirdby.
ⓘ The summary is made with the support of AI tools from OpenAI and quality assured by Aftonbladet. Read our AI policy here.
Show more
chevron-down
A woman in her 30s has pain in her hand and seeks care in the app “Min Vård Gävleborg”.
She then has to answer a number of written questions, including estimating how much pain she has on a ten-point scale.
The woman states eight, but writes in free text that the pain has lasted for several weeks and that she thinks it is due to skiing. Otherwise, she states that she is not particularly concerned.
But the app assesses the situation as urgent and that it must therefore be handled within 30 minutes.
As the woman’s regular health center cannot receive her, the “alert” goes instead to all health centers in the region, where they are expected to handle the case if possible.
– Now this was at lunchtime on a weekday, but if the patient had applied during on-call hours, it would have gone straight to the emergency room, explains Alexander Wirdby, specialist in general medicine at the privately owned Eira health center in Gävle.
expand-left
full screenRegion Gävleborg’s chatbot is supposed to make care more modern. Photo: Mats Strand
“A crazy product”
He is critical that patients in the app, whose software is currently used in 19 out of 21 regions, may receive too high or too low a priority. Something that could endanger patient safety, which he and several colleagues has been highlighted in various debate articles.
– We who work in primary care and handle most of the cases on the floor, are completely convinced that this is a crazy product, he says and adds:
– The resources we have and the times available risk being taken up by lower priority matters, says Wirdby.
Although Region Gävleborg is at the forefront when it comes to developing the app, there are also several examples from other regions where patients have been “incorrectly prioritized”.
expand-left
full screen Photo: Fredrik Sandberg/TT
FACT This is how the care apps work:
arrow At the end of 2022, Sveriges Kommuner och Regioner, SKR, through its subsidiary Inera, procured the possibility of having a chatbot make an initial assessment when patients seek care digitally via 1177.
arrow A total of 11 out of 21 regions took up the offer – after which another eight regions concluded their own agreements with the Investor-owned company Platform24, which with the procurement landed a multi-million dollar contract.
arrow Only two regions chose to be outside: Blekinge and Stockholm.
arrow The apps can have different names and offer different functions depending on which region you seek care in. Some are more standardized, while, for example, Region Gävleborg has its own medical content and functionality.
arrow Simplified, the apps are intended to function as a digital route into care and a way to relieve, for example, 1177’s telephone service. The patient logs in with Bankid and then meets a chatbot and then describes his symptoms in writing. This takes place in the form of a cross with the possibility to develop the symptoms in free text.
arrow The patient is then screened further with the help of a triage engine infoclosetriage engine The word triage comes from the French “trier” which means to sort/prioritize. and receives a priority order between 1 and 5. Then, depending on the priority, the patient is offered different options: either a guide for self-care, a chat or a video call with a nurse/doctor, an invitation to call 112 or go to an emergency room.
arrow What the price tag has become for the regions is difficult to completely overview. However, it is about multi-million dollar amounts, where targeted government subsidies have been a large part of the financing.
Read more
The most serious is from Region Jämtland Härjedalen where the system at the time was unable to manage both acute and chronic conditions at the same time, which led to a missed heart attack.
The woman who sought treatment was supposed to rate her pain, but as she had both acute and chronic pain from before, she was given a three instead of a one.
In the chat, she was also advised to continue with pain relief and physiotherapy. Two days later in the emergency room, it was found that the woman had an ongoing heart attack.
The matter was reported to Lex Maria and the system was paused pending investigation. However, it showed shortcomings in the organization and work routines around the digital service, rather than the system, whereupon the app started up again with new routines and ways of working.
“Can be misinterpreted”
Henrik Kockum is the chief physician in the region and participated in the investigation.
He states that the tool can be good for high patient flows or to reach new patient groups, such as young people, but believes that it also has its limitations, so it is important to be critical of the results of the prioritization.
– There is a risk that the service could be misinterpreted as a diagnostic tool when it is instead about sorting. But I feel that there is greater security in the system today, but that does not mean that the product is error-free. But on the other hand, that’s not reality either. Patients are wrongly prioritized even in the emergency room.
After the introduction, the Västra Götaland region has also put its service on hold since last summer. However, the fact that they have not started up again is not due to the product as such, explains digitization strategist Erica Sandberg.
– Since all regions are organized in different ways, the idea is to be able to adapt the service based on each individual region. For us, it’s about finding a way of working with contractors and opening hours that suit us.
– But the goal is to start up again as soon as possible.
expand-left
full screen Photo: Pontus Lundahl/TT
At the same time, the majority of regions that Aftonbladet has contacted state that they believe that the work with the apps works well and that they are satisfied with the outcome.
Totally expected with deviations
At the time of writing, no further Lex Maria cases have been reported, but a total of five regions have reported a number of patient cases to the Medical Products Agency, which has an ongoing supervision of Platform24, which provides the software, and Inera, which procured it.
However, the inspection is part of a larger e-health project and was planned previously – with one exception.
– The supervision of Platform 24 has been brought forward as we received various signals, such as a lot of questions and reporting in the media, says investigator Sandra Sjöåker.
Platform24’s communications manager Sara Dannborg writes in an email that they welcome the supervision, that they take all criticism very seriously and immediately remedy all deviations.
However, she points out that the security in the apps is very high.
“Our triage solution has triaged many millions of patients without serious patient events and we are confident that it is patient safe,” she writes.
Furthermore, she states that it is “completely expected” that deviations are reported and that it “shows that the quality processes are working”.
“It is also important to understand that the deviations that occur do not equal a patient risk. It has also been about views on word choice, implementation or suggestions for adaptations. In relation to the large number of patients who used the solution, only a small number of cases have concerned the risk of patient harm caused by the platform.
“Never be 100 percent accurate”
Sofie Zetterström, business area manager for 1177 at Inera, is aware of the criticism directed at the apps.
– This is always the case when you introduce new technical solutions. But healthcare is facing enormous challenges and we therefore need to find new ways of working.
However, she thinks that in some cases the debate has placed too much emphasis on technology, and believes, like Henrik Kockum, that it is at least as important how you organize yourself behind it.
– It is absolutely crucial if efficiency and safety are to be achieved in the service.
She believes that deviations were discovered during the introduction is part of the process.
– We have a great dialogue with the regions and the supplier, and I feel that the errors and shortcomings that appear are quickly remedied. At the same time, this is new technology and it will never be 100 percent accurate, but so is manual handling.
– Our goal is for the service to be as secure and seamless as possible.